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HomeMy Public PortalAbout5001 ENCINITA AVE_Building__ 78AS38A CE#•809.7 88 APPLICATION FOR BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDING ADDRESS Department of County Engineer County of Los Angeles LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST CASSATT D GRIFFIN. SUPT OF BUILDING CROSS ST DISTRICT NO GROUP (TYPE SEWER MAP FOR APPLICANT TO FILL IN BK P CONS BUILDING n T .C. — T1 ADDRESS 5001 Enc lnpi to Ave , 1 .C• STATISTICAL CL.A SIFICL UN LOT NO ` 7� BLOCK CLASS NO DWELL UNITS MAP STATE YES ,j NUMBER HWY TRACT` W USE ZONE SPECIAL NO OF BLDGS ] CONDITIONS SIZE OF LOT / J IV NOW ON LOT 2 M USE OF -D Velllnp & kennel EXISTING BLDG t7 BUILDING YARD HWY SIMEET NAME EXIST Hill SETBACK WIDTH OWNER Sam Hill & June ll FRONT / I ADDRESS 5001 Enc i ni to Ave T.C. SIDE c,, Temple City TEo T72336 P L INSPECTION RECORD ARCHITECT OR TEL ENGINEER NO ADDRESS CONTRACTOR WTNTERBOTTOM N,AT25117 [Y ADDRESS909 W. Las Tunas Dr. S• Ga • �� � G® � DESCRIPTION OF WORK CD NEW ADD ALTER X21REPAIR DEMOLISH SO FT OF NO OF SIZE STORIES 1 FAMILIES 1 USE OF STRUCTURE /' r Fa mi Y w . l ink • APPROVALS SIGNATURE OF APPLICANT DATE INSPECTOR S SIGNATURE ADDRESS FOUNDATION LOCATION _ FORMS MATERIALS P $ FRAME R STOPS l� 1500.00 FEEEBRACINGBOLTS VALUATION 3 FURNACE LOCATION FEE GAS VENT DUCTS 1 HEREBY ACKNO ED HAT 1 VE READ THIS AP- LATH INT PLICATION AND STAT T THE EIS COR CT AND AGREE TO COM LY IT SCO Y OR IN ES AN LATH EXT STATE LAWS EG I RUC SIGNATURE OF _ OUSE NUMBER COR- PERMIT! T AND POSTED ADDRESS W. Las Tunas r• S Gab FINAL JOHN A LkMBIE. COUNTY ENGINEER CLYDE N DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION M o CASH -• _ _ L4E03 1, 5 6 F .AIL 2 4 1 A 8-50 M 76AG38A CE#803 9-67 APPLICATION FOR BUILDING PERmIT COUNTY OF LOS ANGELES BUILDING DEPARTENT OF COUNTY ENGINEER ADDRESS ^U O ! =N�t Mry r/6C_.J BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUP T OF BUILDING NEAREST J CROSS S T PEXISTING OR APPLICANT TO FILL IN DISTRICT NO GROUP TYPE Pf+tOCESSED BY (Print or type only) `�`rL>�� Slsl. JT (�����-" / > STATISTICAL CLASSIFICATION SEWER MAS (,'C / 4/1 1C 1.4/1 CLASS NO � DWELL UNITS M BK PG 4'i_ BLOCK USE ZONE No O / 1 T1 ( �� M SPECICONDAL ONS NO OF SLOGS 5• K( NOW ON LOT DG BLDG SETBACK FROM _ TEL F-RONTPROP LINE OF CIIV -/N/'C( (STREET) OWNER NO -`7 -.3535 TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL i ADDRESS•S a C' /1 F d f I- A //.� HIGHWAY WIDTH FROM C L CITY /C/q L- rjVr -F BLDG SETBACK FROM ARCHITEC R TEL SIDEPROP LINEOF (STREET) ENGINEER F po _ TYPE OF EXISTING SETBACK +, YARD - TOTAL .� ADDRESS HIGHWAY WIDTH FRO _ TEL +%1 = d CONTRACTOR NO LIC ADDRESS NO CORNER CUTOFF YES �❑ NOCD U CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS. DESCRIPTION OF WORK N l9, z ADD ALTER REPAIR DEMOLISH �ti_IJ1 SQ FT NO OF NO OF SIZE STORIES FAMILIES /Q 6� \ USE �I �` nn STRUCTURE uL.CX— 6 1 SIGNATURE OF APPLICANT v� VALUATION $ APPROVALS A1E INSPECTOR'S URE P C PMT FOUNDATION LOCATION FEE $ FEE $ �C./© FORMS MATERIALS FRAME FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT LATH, INT ING TO WORKMEN S COMPENSATION INSURANCE LATH EXT SIGNATURE OF Lr /% HOUSE NUMBER COR- PERMITTEE '� "+ RECT AND POSTED ADDRESS AQ FINAL G� JOHN F LEWIS PRINCIPAL 5.TF UCTURAL EN PLAN CHECK VALIDATION CK M O CASH _ PERMIT,VALIDATIO CK MO CASH LAL,o 6 0 5 4 . ;ue 2 � 9.00— v 76A63BA DBS S 3-56 ` JAPPLICATION FOR BUILDING PERMIT 1 DIVISION OF BUILDING AND SAFETY BUILDING Department Of County Engineer ADDRESS rYfdo ` o� County Of LOS Angeles LOCALITY IsesiO .Q� WM J FOX, COUNTY ENGINEER NEAREST CASSATT D GRIFFIN, SUP T OF BUILDING CROSS ST D18TRICT NO. I' I TI�PE I S BK MA PG FOR APPLICANT TO FILL IN coNs 140m— A4 BUILDING p MAP STATE ADIRE" / ` 6R..� �•+" �. NUMBER D / HWY YES NO LOT NO `s G� •�Qd' d� BLOCK USE ZONE SPECIAL CONDITIONS TRACTS (� Q NO OF BLDG$. BUILDING EXIST. SIZE OF LOT T J / /� NOW ON LOT SETBACK YARD HWY STREET NAME WIDTH USE OF EXISTING BLD FRONT �D ♦ '� 1�M ` P L. 4� K✓i•� / OWNER SIDE_ P L. MAIL ADDRESS D.o o"'i Iv TRACT DWELL. f UNIT �a 5 INDUSTRIAL CITY .6�'I'�V1? NO DWELL. f UNIT IEUBLiC BLDG 2 DUPLEX f UNIT` ARCHITECT OR� � TEL. 7 ADDN ,ALT. ETC. ENGINEER NO. 3 APT UNITS 8 MISCEL. ADDRESS 4 COMMERCIAL TEL CONTRACTOR r���-�'�Y` NO/T/ / ,��� INSPECTION RECORD ADDRESS DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ FT. qq NO.OF NO OF SIZE �4, / SI [/ 'STORIES FAMILIES l USE OF STRUCTUREE,l�jfrj /E SIGNATURE OF �� low v APPLICANT {/�q- APPROVALS ADDRESS 'rail// DATE INSPECTOR'S SIGNATURE FOUNDATION LOCATION $ P. C $ FORMS, MATERIALS 2 FEE FRAME FIRE BRACING. STOOPS VALUATION FEE OLTS FURNACE LOCATION. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ 7H18 GAS VENT, DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH. INT. r AND STATE LAWS/ REGULATING BUILDING „CONSTRUC- ry �A ' TION. q' ,LATH, EXT ( SIGNATURE OF �A�±�^ HOUSE NUMBER COR- 1 PERMITTEE - RECT AND POSTED I ADDRESS �� FINAL �1 1M'F� WM.J FOX,COUNTY ENGINEER VALIDATION C. N DIRLAM. CHIEF BLDG. INSPECTOR ���0 3 5 3 5 L FEB 2 7 1 600 m y�q/�_ �.4i 1p.� � 1 gwve■/►� � i8A898A CE#809-1O S Ai P P�0 GA , I®N ■ ®R B V' L D -tl d G-P_ E R 1�9-I ' _ BUILDING AND SAFETY DIVISION BUILDING t Department of County Engineer ADDRESS , l County of Los Angeles LOCALITY` • JOHN A. LAMBIE. COUNTY ENGINEER NEAREST CASSATT D GRIFFIN, SUPT OF BUILDING CROSS ST y�- '"✓ DISTRICT NO I GROUP ITy,e SE K�aMAPP FOR 77PLICANT TO FILL IN CONST- BUILDING ✓ ° STATISTICAL CLASSIFICATIONADDRESS i CLASS NO DWELL UNITS LOT NO�� S �fiVLOCK MAP STATE YES NUMBER HWY TRACT. ♦z /Ss- - USEZONE SPECIAL SIZE OF LOT / ,yam ! I NO OF BLDGS IIL� J CONDITIONS NOW ON LOT USE OF _ EXISTING BLDG BUILDING EXIST SETBACK YARD HWY STREET NAME WIDTH- OWNER , FRONT f -MAIL ► P L ADDRESS -06/ SIDE - TEL.n� P L CITY Not' .9 INSPECTION RECORD ARCHITECT 04 TEL ENGINEER NO /G — ADDRESS /` TEL CONTRACTOR . NO - ADDRESS DESCRIPTION OF WORK /RI NEW ADD ALTER REPAIR DEMOLISH SQ T �� �j / NO OF NO OF SIZE �j (p STORIES FAMILIES USEOF TRUCTURE i I APPROVALS SIGNATURE O - / APPLICANT DATEvC ryINSPECT&'Sy/SIGNATURE ADDRESS FOFORMSTMATERIALSION�� ei_^L_nsl,�.�� P C S FRAME FIRE STOPS. FEE BRACING BOLTS ( .w VALUATION s B_ FURNACE LOCATION FEE GAS VENT DUCTS 1 HEREBY ACKNOWLED THAT 1 HAVE READ THIS AP- LATH INT PLICATION AND STATE TH THE AB IS CORRECT AN q -I f LW��o� „ AGREE TO COMPLY WIT LL COUNT R 5tt! LATH EXT STATE LAWS REGU NG BUILDI O SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN A LAMBIE.I OUNTY ENGINEER CLYDE N DIRLAM. PRINCIPAL STRUCTURAL ENA ER PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK M o CASH 2349 SEP 17 1 6.00 //089_3 23M SE'_ '���`---.J `��� - 7 - a --_`\ DEPPARTIMENT OF BUILDING AND SAFETY' Y- APPLICATION FOR COUNTY OF LOS ANGELES J WM. J. FOX, CHIEF ENGINEER B U I L D I N G FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING kyr/y �ADIBTRIC NO. PLAN CK NO. PERMIT NO. ADDRESS p�f ` 1 � ' .JD y/_. -17 2.97k LOCALITY �1-4"A RECEIVED BY^ DATE OF APPL. DATE ISSUED NEAREST � CROSS ST.� fi 4.", BUILDING OWNER ADDRESS MAIL P'J'1� f // I LOCALITY (LjffA_sECO I� ADDRESS NEAREST C�.L�e!' wuA6tidh � NOL' CROSS BT -LS°LS FIRE NO OFI TYPE �y I GROUP� ARCHITECT OR� TEL ZONE c� v PLANS !J!J ENGINEER NO - -� BLDG ORD. NO. ADDRES9 SETBACK LINE \ APPROVED TEL - CONTRACTOR AQ NO BY DATE USE APPROVED ADDRESS ZONE ! BY DATE LEGAL CORRECTIONS DESCRIPTION I LOT NO <'� I• BLOCK TRACT 05 �� NO DF BL SIZE OF LOT' NOW ON LOT USE OF NO OF NO OF EXISTING BLDG r I FAMILIES A.ROOMS SG�� /C G� /��. c ye, DESCRIPTION OF WORK NEW ALTERATION ADDITION O A REPAIR MOVING DEMOLISHSQ O NO OF SIZE ROOMS ��STORIES WALL `1 I ROOF t ' COVERING ., COVERING ,,��,�d� USE OF NEW 'a BUILDING ,R � I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION LOCATION, I PECOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS 7 2- 16 AND STATE LAWS REGULATING BUILDING CONSTRUCTION FRAME: FIRE BTOPB, SIGNATURE OF BRACING, BOLTS OWNER ? LATH, ,INT.: �/2/�t �J"���✓ C 1.1/G AUTHORIZED AG T _ LATH, EXT: $ P C !$ PLASTER, INT. :.� FEE PLASTER, EXT. �y VALUATION� �1 y � FINAL FEE.er �y6 6;3 26M 6ETH 2-48 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES 't WM. .1. FOX, CHIEF ENGINEER BUILDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK NO. PERMIT NO. BUILDING ADDREB8 LOCALITY '/ ..X� ' REGfLiVED_'8 DATE OF//APPL. DATE ISSUED NEAREST CROSS ST. v BUILDINC OWNER ��/ ADDRESS � i MAIL ,(� v ^LOCALITY ADORES 8 /,/�' NEAREST �f CITY �Y/Y_�•� �e l .s 67 NOLO CR099 ST /t FIRE NO OF / I TYPE I ORO ARCHITECT OR TEL ZONE" PLANS ENGINEER A-1'w NO: r r _ BLDG ORD. NO. ADDRESS SETBACK LINE 210 APPROVED TEL CONTRACTOR NO - - _ BY DATE UBE APPROVED ADDRESS zZONZ`7 BY J ` DATE LEGAL -- CORRECTIONS DESCRIPTION C I LOT N/O./ �� I BLOCK TRACT �,/J • �/6�J'" r." SIZE OF LOT V /t, ! ®I NO OF BLDGS //�-�/�� NOW ON LOTUSE � EXISTNG BLDG. ( // ff,.Qf�../ �I F MI IE I ROOMS - + DESCRIPTION.OF WORK 5� NEW _ALTERATION ADDITION' O 0 REPAIR MOVING DEMOLISH, O_ 9q. FT. NO OF 4 SIZE ROOMB STORIES. WALL ( ROOF COVERING i COVERING USE OF NEW BUILDING _� —0- e,', , ' I HEREBY 'ACKNOWLEDGE THAT I HAVEREAD THIS' APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, I SPE TOR' DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION FRAME, FIRE STOPS, ly SIGNATURE OF ///JJJ BRACING, BOLTS - OWNER ` LATH,'INT.: ' AUTHORIZED AOT (/;, r - LATH, EXT: s $ ► P C PLASTER, INT " PLASTER, EXT. v VALUATION FEE „3 FINAL ' / - r 7GA638A CE#BQ9.1'56 APPLICATION F'O R BUILDING PERMIT 1 BLWING AND SAFETY DIVISION ADDRESS BD Department of County Engineer County of Los Angeles LOCALITY JOHN A LAMBIE. COUNTY ENGINEER NEAREST _ CASSATT D GRIFFIN, SUPT OF BUILDING CROSS ST LTJ DISTRICT�Njg GROUP TYPE SEWER MAP FOR APPLICANT TO FILL IN G BUILDING� CONST ' - � � � p - I ADDRESS _© � � � Gp��. STATISTICAL LASSIFICATION - o CLASS NO DWELL UNITS LOT NOS BLOCK MAP STATE NUMBER HWY YES O TRACT S ee /k T/ S! I? it, USE ZONE SPECIAL NO OF BLDGS O CONDITIONS - SIZF-OFLOT'yd—X I NOW ON LOT y 1 USE OF EXISTING BLDG BUILDING EXIST SETBACK YARD HWY STREET NAME - WIDTH OWNER d {. FRONT SIDE , P L CITY L Po U .�:,/ NO INSPECTION RECORD _ ARCHITECT OR TEL ENGINEER NO ADDRESS TEL CONTRACTOR v., N"+ V - ADDRESS d—a-UZ) DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SO FT NO OF NO OF SIZE STORIES FAMILIES -USE OF STRUCTURE - " 1. , _ - APPROVALS Y SIGNATURE OF APPLICANT - DATE INSPECTORS SIGNATURE ADDRESS FOUNDATION LOCATION FORMS, MATERIALS ' S'7 - -+� $ �` (, P C $ FRAME FIRE STOPS, -~ FEE BRACING BOLTS VALUATION $ FURNACE LOCATION FEE --�+ GAS VENT DUCTS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH. INT PLICATION AND STATE THAT THE ABOVE IS CORRECT AND r AGREE TO'COMPLY WITH ALL COUNTY ORDINANCES AND LATH EXT i STATE LAWS REGULATING BUILDIN CONSTRUC710N SIGNATURE OF HOUSE NUMBER COR- PERMITTEE Wg �� '�� RECT-AND POSTED.-.... FINAL / 1�l �'s'�� 16f�A.4i. JOHN A LAMBIE, COUNTY ENGINEER CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK m o cA PERMIT VALIDATION CK m o CASH IAf,39 7 6 3 0129 1 2.00 �' i . 714� 71 76A638A CE #803 3-69 r APPLICATION FOR BUILDING PERMIT CnNTY.OF LOS ANGELES BUILDING S 's �i►tc/Y.� [ GP d� DEPARTMENT OF COUNTY ENGINEER ADD • r�BUILDING AND SAFETY DIVISION LOCALITY �Q JOHN A LAMBIE, COUNTY ENGINEER 1*7 COLEMAN W JENKINS, SUPT OF BUILDING NEAREST CROSS ST (,i/Qt- A7 rie, FOR APPLICANT TO FILL IN DISTRICT NO GROU TYT PR OC ED BY (PRINT OR TYPE ONLY) 5", 06 BUILDING STATISTICAL CL SIFICATION S WER P ADDRESS Q �,��,I �C CLASS NO DWELL UNITS BK PGGS LOT NO E'E' 04y7C Cp BLOCK USE ZONE NOP TRACT SPECIAL ' NO OF BLDGS CONDITIONS SIZE OF LOT S- NOW ON LOT USE OF EXISTING BLDG C['h r- c— BLDG SETBACK FROM OWNER �'r Lf��F NOL FRONT PROP LINE OF Fti _e*_ Dov_ (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS !fjC A..v HIGHWAY WIDTH FROM C L CITY I ARCHITECT OR TEL BLDG SETBACK FROM - (STREET) ENGINEER NO SIDE PROP LINE OF TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L L4:/v� t7 TEL jZ' + CONTRACTOR �*aAjT 7pe,S =M NO _.303 CL ADDRESS jLIC Z 1�-AIV 'trOD NOZZ.bOZ. _ --CORNER CUTOFF YES ❑ NO ❑ 0 CITY �j�;��' CLASS �— ( SEE REVERSE SIDEFORSPECI L APPROVALS CONSTRUCTION LENDE ~ NAME AND BRANCH C _ 1, IiC.� w N ADDRESS z SO F 58ISO OF FAMILIES A OF SIZE SFAMr C STORIES ILIES NEW STRUCTURE � Aa9�'Tlo►J USE OF ADD ❑ - ALTER ❑ �.t7 �BC� REPAIR El SIGNATURE,Wj DEMOL ❑ APPLICANT ��y'`�M/��/'�� VALUATION $ vW APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION LOCATION FEE $ FEE $ ��� Zf FORMS MATERIALS o I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME FIRE STOPS,` BRACING BOLTS AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- GAS VENT DUCTS TION I CERTIFY THAT IN DOING THE W HEREBY I WILL NOT EMP Y ANY PE IN'VI ATION OF TH A CODE LATH, INT OF THE STAT F CALIF O IANN LATING TO WO KMEN' COM- PENSATION INPU VAN �" \ 1\ LATH, EXT SIGNATURE 0 HOUSE NUMBER CORRECT PERMITTEE AND POSTED ADORESlbi9t� FINAL - 71-1 s JOHN F LEWIS, PRINCIPALST URAL ENGINEER PLAN' CHECK VALIDATION CH M 0 CASH _ PERMIT VALIDATION cK r m O CASH LAlrc 1 s 15 2 te+ AtS 2 5 1 D 3 825-5' 1NOFKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent.to self insure, or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING- PERMIT or a certified'copy.theteof (Sec 3800, Lab C ) - COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company BUILDING j Enc ^ �L ' '❑ Certified copy is hereby"furnished FOR APPLICANT A ATO FILL IN�� ADDRESS I 1 \ TaJ t❑ Certified copy is filed with the county building inspec- ADDRESS IDING 6701.�NGI Jy II'N 4Y/ „tion department ryry VW CITY Pj Pi li ZIP V/ / o LOCALITY I� Date Applicant /��nn .// )/� O OF BLDGS CERTIFICATE OF-EXEMPTION FROM WORKERS' SIZE OF LOT��l!� /!�/,73NOw ON LOT NEAREST- / „, r ZG�`` CROSS ST l� u)r✓r need INSURANCE ASSESSOR S3�r, (This section not be completed if the permit is for one TRACT BLOCK LOT NO P BOOK a �G PAGE PARCEL ©� ,hundred dollars ($100) or less ) t OWNER Ci�C�//�✓ p � •��3 �S USE ZONE MAP I certify that in the.performance'of the work for which this '/y�`//� �y NO permit is issued, I shall not employ any person in any manner ADDRESS ©�� 1"-WC,1/✓/',I . Y3 � ' SPECIAL CL CONDITIONS so as'to become subject to the,Workers'Co�"pensaTion Laws � O '� � /�/ 1 CITY ivt `� / ZIP t/79-0 Date r!Applicant ARCHITECT OR L 1 '.. p�/ S3S' DISTRICT GROUP TYPE •FIRE PROCESSED BY O NOTICE TO APPLICANT If, after making this Certificate of ENGINEER O CO ZONE ~ Exemption, you should become subject to the Workers' U .Compensation provisions of the Labor Code, you must forth- ADDRESS �r O� 3 w a with comply with such provisions or this permit shall be �ATEL ATISTIC SSIFICATION APT CONDO N deemed revoked CONTRACTOR C y"INErict� NO f Z LICENSED CONTRACTORS DECLARATION ^� LIC CLASS NO DWELL UNITS — I hereby affirm that I am licensed under provisions,of Chapter 9 ADDRESS i• J� ;eir NO 3 S ^ LIC 9 SEWER MAP (commencing with Section 7000)of,Division 3 of the Business �(J•/!// - w and Professions Code,and my license is in full force and effect CITY CLASS BK PG VALIDATION SO FT/�- � O OF NO OF y� CHECK License Number Lic Class SIZE /f�/�' / ORIES FAMILIES QCT ONE T VALUATION DESCRIPTION OF WORK NEW ❑ S Contractor Date �- / ❑ s d D O At y I e T ❑1 am exempt under Sec R� ,46- )��� /�- ► 331, t NEMS�t B&P C for this reason f�V S 10 CV C✓L/ �y L REP R 4K $ 1 .L 1 EMS USE OF /'' /� �,�}'��,p� REPAIR -129 - 33 Date EXISTING BLDG CA �'�Er� DEMOL ❑ TOTAL Signature APPLICANT FINAL ( HE K OWNER-BUILDER DECLARATION (PRINT)` �y dA110 cf.5 '1P I hereby affirm that I am exempt from the Contractor's License /1 'A DATE CH I Law for the following reason (Section 7031 5, Business and ADDRESS FINAL ^ 7ssions Code) I I PRESENT �j /`�/�,'a 1 J By 1, as owner of the property, or my employees with ADDRESS" ��� �" — N I�� C I�l)IIXI 01 2 51-jl! wages as their sole compensation,will do the work and �r7 ' j the structure is not intended or offered for sale(Section [ADDR LITY gmp� (i/// , H-66 ] A t e t-, 7044, Business and Professions Code ) NG TEL ❑ 1, as owner of the property, am exclusively contracting RACTOR NO 1 with licensed contractors to construct the project (Sec- ESS 1 tion 7044, Business and Professions Code ) UIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY BACK YARD HVVY PROP LINE WIDTH + I hereby affirm that there is a construction lending agency for NT the performance of The work for which this permit is issued(Sec 3097, Gv, C ) AA Lender's Namer33LDMA Ref #ee$ Permit Fee � Lender's Address /�� 0 1 certify that I have read this application and state that the Issuance Fee 1� V LDMA P/C# z� . �s3 8 above information is correct I agree to comply with all County Investigation Fee R ordinances and State laws relating to building construction, Total Fee LDMA Perm # a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection ppu�rpose�s �,vim, �` / G(/✓ =~ 9 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date